Gerdhater Linx Journal 2

GM, yes I am on PPI.

tracks83: Answers to your questions below.
30th Jan 2013.
Yes.
Yes.
USC Keck by Dr. Lipham.
Yes, sphincter was patulous.
I think so.

I am still refluxing, no doubt. Still on PPIs. Breathing is horrible too, especially after meals.

I have written to Dr. Lipham and he suggested a Bravo probe.

I think I need a dual probe, however, to measure reflux at throat level as well.
Can anyone suggest what the best test out there to do this is?

GH

Hi GH,

You may have already seen this, but it gives a pretty good description of the ways MII can be used:

http://www.uptodate.com/contents/esophageal-multichannel-intraluminal-impedance-testing

It says:

When combined with pH testing, it allows for detection of gastroesophageal reflux independent of pH (ie, both acid and non-acid reflux).

But a dual-channel pH sensor might be more what you're looking for.

Here's the link:

http://gi-gudiagnostics.com/laryngo-pharyngeal-reflux-role-of-ambulatory-dual-channel-ph-testing/

I know it's what my asthma doc wanted me to get tested with.

Good luck!

Denise

Hi GH,

Please check on this doctor - he might be able to help.

http://www.lambroza.com/

He's in NYC.

Feel better,

GM

Hi GH,

I don't know if you've already seen this, but it looks pretty informative.

The article is entitled, The Role of Multichannel Intraluminal Impedance and pH Monitoring in the Diagnosis of Gastroesophageal Reflux Disease.

That's a mouthful!

http://www.touchbriefings.com/pdf/2899/vela.pdf

Hope you find it helpful!

Denise

 

GM,

Thanks for the info. Hoping it goes well. Will keep you posted.

GH

Hi GH,

Has this problem been ruled out in your case?

http://www.hindawi.com/journals/rrp/2011/460890/

GM

Another small update:

My gastric emptying study seems to be normal.
I looked at the raw numbers and it seemed like my stomach was emptying faster if anything.

GH

Hi GM,

After talking to Dr. Lipham, we decided to repeat the battery of tests to assess current reflux conditions.

I am expecting the tests to show:
Reflux abnormal but highly improved than before.

I've stopped PPI cold turkey last week for the 24 hr test with Dr. Lambroza this week.

GH

GM,

Will do.

Curious, what is your research telling you about Linx so far ?

GH

GH, what did you notice when you stopped the ppi's cold turkey? Was there a noticeable change in reflux symptoms?

Update:

I am now 3 months post Linx (surgery date: Jan 30).

I had a manometry/24 hr test 10 days ago.

Objective data first.

24 hr pH test:
Numbers pre op and post op
#of acidic reflux episodes:Went from 150+ to 8. Normal 48. I also had 32 non acidic episodes.
Longest acidic episode: Went from 29 minutes to 1.5 minutes. normal 20
% time pH < 4: 14% to 1%. normal 4%
Episodes over 5 min: 6 to 0. normal 3
DeMeester score: 52+ to 1.9. normal 14.7

The catch
The downer however is all my acidic reflux episodes (8 of them) have a pharyngeal presence. Clearly it needs to be stopped and I have no idea how to.

Manometry
It was hard, pretty hard to get the catheter through the Linx.
LES pressure: 8 to 11 mm Hg (normal 15+). So, pressure is still on the lower side.
Esophageal peristalsis: 8 good, 2 bad swallows out of 10. Amplitudes are all on the lower end of normal.
UES pressure: 85 mmHg (high end of normal)

Misc
I am taking speech therapy sessions to use voice efficiently as there has been some residual damage to the vocal folds.

How I feel
- I am now off PPIs for almost 3 weeks without any heartburn. Happy about this
- Breathing still as bad as ever
- Sleep study demonstrated apnea. CPAP machine unhelpful so far.
- Most of my reflux is associated with belching. And unfortunately, most of the reflux I can feel in the throat. When the pressure is too high, the Linx opens up and the force brings reflux all the way up to the throat.
- Dysphagia is for the most part gone. It does show up when starting a meal and gulping a couple of shots of water usually resolves it.

What I feel about Linx
If you are just being diagnosed with GERD (1 year or so since heartburn) without LPR like symptoms, Linx is probably a VERY VERY good bet. I think surgical morbidity rates these days are approaching very good numbers (i'd want to say close to drugs, but i don't have data) and Linx is a good candidate for *early* GERD patients. The conservative wait and see leaves too much residual damage IMHO.

If however, you have LPR like symptoms, Linx's effectiveness is still up in the air for lack of data.

Doctor Recommendation

Gastricman, this is for you.

I got my recent tests done by Dr. Arnon Lambroza. I recommend him. He seemed *logical*. When I expressed a doubt as to whether I had sufficient days off of PPI, he first made sure that my stomach was producing acidity by dipping the catheter deep into the stomach and confirming pH was < 2. This enabled him to use the dual probes more effectively, one at LES and one at pharynx instead of wasting one of them at the stomach level (just to make sure stomach was producing acidity). He also gave me a reasonable explanation as to why he thought Restech gives too many false positives, which he said came down to patient inability to note down every little detail of solid/liquid that they ingest. Overall, I recommend him at least for testing purposes.

The doctor who did the test presumed that non acidic reflux is probably due to some stuff staying above the Linx. We don't have a clear answer.

I did expect the LES pressure to be higher and was more than a little bit disturbed by the measurement.

However, I think regularly manometry COULD under report the actual LES pressure. Why ? The catheter changes the diameter of the esophagus, increasing distance between magnets, dropping the attraction force (and hence the LES pressure).